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MUltraril"aInc.In 0 <br /> '�J <br /> utrainar <br /> CHAIN OF CUSTODY REPORT BEACON <br /> Beacon Station No Sampler(Print Name) i I DateAForm No <br /> 6: car 16c(�-k f, I <br /> ANALYSES of '2-- <br /> Project No 141 ( 2 Sampl r(Signat re) � <br /> 1 <br /> Project Location Affiliation � <br /> 7` l� M T c� r/4 7 <br /> `o <br /> Sample No/identification Date Time Lab No UJ~ i,— a z REMARKS <br /> r r <br /> � U — may <br /> ` oS -- <br /> D�' <br /> Relinquished by (Signatur ffiliation) Date Time Received by (Signature/Affiliation) Da e <br /> Relinquish by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> &)a /_qCk'J'Y'� !;/%' /J,?C) <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Afliliation) Date Time <br /> o � <br /> Report To Bill to ULTRAMAR IN <br /> 525 West Thtr St r et <br /> Hanford, CA 93 0 <br /> ( Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32!0031190 <br />